Telerehabilitation improves physical function and reduces dyspnoea in people with COVID-19 and post-COVID-19 conditions: a systematic review

Abstract

Question: How effective and safe is telerehabilitation for people with COVID-19 and post-COVID-19 conditions?

Design: Systematic review of randomised trials.

Participants: People with COVID-19 and post-COVID-19 conditions.

Intervention: Any type of telerehabilitation.

Outcome measures: Satisfaction, quality of life, adverse events, adherence to telerehabilitation, dyspnoea, functional performance, readmissions, mortality, pulmonary function and level of independence.

Results: Database searches retrieved 2,962 records, of which six trials with 323 participants were included in the review. Breathing exercises delivered via telerehabilitation improved 6-minute walk distance (MD 101 m, 95% CI 61 to 141; two studies), 30-second sit-to-stand test performance (MD 2.2 repetitions, 95% CI 1.5 to 2.8; two studies), Multidimensional Dyspnoea-12 questionnaire scores (MD -6, 95% CI -7 to -5; two studies) and perceived effort on the 0-to-10 Borg scale (MD -2.8, 95% CI -3.3 to -2.3; two studies), with low certainty of evidence. Exercise delivered via telerehabilitation improved 6-minute walk distance (MD 62 m, 95% CI 42 to 82, four studies), 30-second sit-to-stand test performance (MD 2.0 repetitions, 95% CI 1.3 to 2.7; two studies) and Multidimensional Dyspnoea-12 scores (MD -1.8, 95% CI -2.5 to -1.1; one study), with low certainty of evidence. Adverse events were almost all mild or moderate and occurred with similar frequency in the telerehabilitation group (median 0 per participant, IQR 0 to 2.75) as in the control group (median 0 per participant, IQR 0 to 2); Hodges-Lehmann median difference 0 (95% CI 0 to 0), with low certainty of evidence.

Conclusion: Telerehabilitation may improve functional capacity, dyspnoea, performance and physical components of quality of life and does not substantially increase adverse events.

Registration: PROSPERO CRD42021271049.

Keywords: COVID-19; Patient safety; Physical therapy; Systematic review; Telerehabilitation.

Figure 1

Flow of trials through the review. ^a One trial was reported in two articles. PICO = Patient Intervention Comparator Outcome.

Figure 2

Risk of bias of the included studies assessed using the Cochrane Risk of Bias 2.0 Tool.

Figure 3

Detailed forest plot of the mean difference (95% CI) in effect of breathing exercises delivered via telerehabilitation for 2 weeks compared with no rehabilitation on functional capacity assessed by the 6-minute walk test (m), based on pooled data from two trials.

Figure 4

Mean difference (95% CI) in effect of breathing exercises delivered via telerehabilitation for 2 weeks compared with no rehabilitation on performance assessed by the 30-second sit-to-stand test (repetitions), based on pooled data from two trials.

Figure 5

Mean difference (95% CI) in effect of breathing exercises delivered via telerehabilitation for 2 weeks compared with no rehabilitation on dyspnoea assessed by Multidimensional Dyspnoea-12, based on pooled data from two trials.

Figure 6

Mean difference (95% CI) in effect of breathing exercises delivered via telerehabilitation for 2 weeks compared with no rehabilitation on perceived effort assessed by Borg scale, based on pooled data from two trials.

Figure 11

Mean difference (95% CI) in effect of exercises delivered via telerehabilitation for 12 weeks compared with no rehabilitation on functional capacity assessed by the 6-minute walk test (m), based on pooled data from four trials.

Figure 12

Mean difference (95% CI) in effect of breathing exercises delivered via telerehabilitation for 2 weeks compared with no rehabilitation on the 30-second sit-to-stand test (repetitions), based on pooled data from two trials.